Stream: implementers
Topic: Need advice with acute ambulance setup
Jens Villadsen (Nov 07 2017 at 07:57):
Hi all - I would love some input towards modelling the logistics flow in an ambulance acute care setting. I have some data fields that's puzzling me where to put (most of the patient/encounter/observation/procedure is trivial). It especially concerns the following pieces of information:
- incident (could this be a ServiceRequest or is it maybe closer to an Episode of Care): Which would partly contain the incident-location, delivery-location and responsible/managing organization but where to put the incident description and following report (both probably just simple string extensions)? What is also needed is an 'arrival'-priority valueSet and a 'delivery'-priority valueSet.
- I lean towards putting attributes such as hospital-ETA, and patient identification method/type on the Encounter
Input to this would be highly valued
Lloyd McKenzie (Nov 07 2017 at 14:11):
I'm not sure we have a good place for capturing "Incident" and I understand the need. We could use EpisodeOfCare (as incident is primarily used as a grouper for all associated care events), but right now the resource is lacking information that would be used to track an accident, chemical release, employment-related incident, etc. The other possibility would be to leverage the new AdverseEvent resource, but that's more about determining causality than a grouper. Any opinions from EHR vendors on where they would typically capture an incident description such as a traffic accident or work-related accident?
Jens Villadsen (Nov 08 2017 at 09:31):
From AdverseEvent: Actual or potential/avoided event causing unintended physical injury resulting from or contributed to by medical care, a research study or other healthcare setting factors that requires additional monitoring, treatment, or hospitalization, or that results in death.
I wouldn't coin a traffic accident as e.g. resulting from or contributed to by medical care. Accidents can happen without any clinical context whatsoever, and most probably do. If FHIR was to have something like an Incident (and I'm talking from an ambulance-point-of-view), it would need to have a reporter (ref to organization/person/whatever) site (location/organization), a period, a description of the incident/valueSet and maybe even 0..* patients ... And it probably should be called accident and not incident (google says so).
Jose Costa Teixeira (Nov 08 2017 at 09:51):
AdverseEvent is kind of generic and could possibly be tweaked, but I think it is not the best option. Even Encounter seems quite far - the occurrence of the incident is not really a characteristic of the encounter.
Depending on the vendors, would it make sense to look at something like occurrence (a resource on its own?)
Jose Costa Teixeira (Nov 08 2017 at 09:58):
Some codes for diagnosis contain the place of occurrence (ICD10: Y92.146 and V95.43XS are fine examples of specifying locations), but this is not really sufficient for what I expect to be the acute care needs.
Jens Villadsen (Nov 08 2017 at 15:17):
@Jose Costa Teixeira right ... the codes are not of my primary concern (those are actually already taken care of - they are specified on a national level). The primary concern here is to capture, what happened, where did it happen (as in geographical terms) and maybe who is involved
Jose Costa Teixeira (Nov 08 2017 at 15:20):
I think we need another construct for that.
Jose Costa Teixeira (Nov 08 2017 at 15:21):
My point with the codes is that some diagnosis codes were adding some context that could imply a location, but that is clearly insufficient.
Jose Costa Teixeira (Nov 08 2017 at 15:22):
(and those specific codes were interesting :-) )
Jens Villadsen (Nov 08 2017 at 15:25):
hehe :) - so from what I can see I have no other option but to put a couple of extensions on the episode of care capturing those logistical parts of data ... and also a couple on the encounter
Jens Villadsen (Nov 08 2017 at 15:26):
and I'll make sure the profiles will be published for public availability ... but still, I'm seeking input to this part of the domain ;)
Jose Costa Teixeira (Nov 08 2017 at 15:28):
agree, and i would suggest this to be considered in core after some feedback.
Lloyd McKenzie (Nov 08 2017 at 15:49):
It's probably best to submit a change request so that the requirement (and resolution of it) can be tracked.
Brian Postlethwaite (Nov 10 2017 at 09:47):
@Andrew Torres , any thoughts on this?
Drew Torres (Nov 10 2017 at 15:06):
Not sure I can add anything to this topic. It feels specific to ambulance. It feels like most of the data can live in an encounter/observations, or other resources, but I don't understand the interweaving of an ambulance delivery. I know our system would have most of the information is notes, observations, and encounter.
Lloyd McKenzie (Nov 10 2017 at 15:22):
I know some types of health insurance also need to track work-related accidents - and would presumably require similar information. Thus my recommendation for a change request
Brian Postlethwaite (Nov 10 2017 at 23:07):
If the tracking is across encounters for this, then Episode of Care makes sense to me.
Lloyd McKenzie (Nov 11 2017 at 11:41):
@Brian Postlethwaite How would the location and description of the accident/incident be represented in EpisodeOfCare?
Brian Postlethwaite (Nov 11 2017 at 11:42):
I was assuming that would be a part of the encounters that occurred. The EoC would just group them all together if you wanted to track things beyond that. (Ambulatory not my bag either)
Brian Postlethwaite (Nov 11 2017 at 11:43):
Expect those details to be in the clinical content, not administrative content. (except maybe the location of the accident could be in the encounter at the start)
Lloyd McKenzie (Nov 11 2017 at 11:43):
Often you wouldn't have an encounter for an intial workplace accident - but you track everything that happens after that that's related to the workplace accident because it has insurance/billing ramifications
Lloyd McKenzie (Nov 11 2017 at 11:44):
I agree that an initial ambulance visit would be an Encounter
Brian Postlethwaite (Nov 11 2017 at 11:45):
And I would assume that there was some document, or report or questionnaire or something that details the workplace incident. Not the encounter (or EoC)
Jose Costa Teixeira (Nov 11 2017 at 11:45):
I think that this detail would fit into a new structure.
Jose Costa Teixeira (Nov 11 2017 at 11:45):
Extension (or core after some feedback)
Lloyd McKenzie (Nov 11 2017 at 11:46):
Document and Questionnaire are data capture tools, not primary representations
Jose Costa Teixeira (Nov 11 2017 at 11:47):
smth like "occurrence" with location, date, etc.
Jens Villadsen (Nov 15 2017 at 09:55):
could we do a bof on devdays on this?
Jens Villadsen (Nov 15 2017 at 09:55):
@Lloyd McKenzie ?
Lloyd McKenzie (Nov 15 2017 at 11:00):
I'm open to that. Sometime this evening?
Grahame Grieve (Nov 15 2017 at 11:02):
tomorrow, I think, for BoFs now
Grahame Grieve (Nov 15 2017 at 11:02):
I used today up ;-)
Jens Villadsen (Nov 15 2017 at 17:17):
place and time?
Jens Villadsen (Nov 17 2017 at 08:14):
@Lloyd McKenzie you mentioned a resource yesterday during our little chat of modelling ambulance, but something has crushed my memory during the night and I didn't do notes :anguished:. Was it HealthCare service?
Lloyd McKenzie (Nov 17 2017 at 09:54):
Ambulance = Location (it's just a "mobile" location)
Øyvind Aassve (Jul 30 2021 at 10:39):
@Jens Villadsen Hi Jens, we are looking into similar issues as you explored here. There is interest to describe the accident/ incident that is the reason for an ambulance dispatch. Information that we would like to capture includes time, place, problem urgency, type of event, risk etc. What did you end up doing? Cheers
Jens Villadsen (Jul 30 2021 at 13:50):
We ended up extending the Basic resource if I remember correctly. @Ann Merete Duedal Jensen might know if it has changed since then.
Signe Hejgaard Kristoffersen (Aug 04 2021 at 08:02):
@Øyvind Aassve It has not changed since then - we are still using a Basic resource with extensions for incident status, responsible organization, severity, address and incident dispatch message.
Øyvind Aassve (Aug 04 2021 at 13:35):
@Jens Villadsen @Signe Hejgaard Kristoffersen Thanks a lot for feedback!
Last updated: Apr 12 2022 at 19:14 UTC
